Epididymitis

  • Men who have epididymitis typically have unilateral testicular pain and tenderness; hydrocele and palpable swelling of the epididymis usually are present
  • Testicular torsion, a surgical emergency, should be considered in all cases, but it occurs more frequently among adolescents and in men without evidence of inflammation or infection
    • Emergency testing for torsion may be indicated when the onset of pain is sudden, pain is severe, or the test results available during the initial examination do not support a diagnosis of urethritis or urinary-tract infection
    • If the diagnosis is questionable, a specialist should be consulted immediately, because testicular viability may be compromised
  • The evaluation of men for epididymitis should include the following procedures.
    • A Gram-stained smear of urethral exudate or intraurethral swab specimen for diagnosis of urethritis (i.e., >5 polymorphonuclear leukocytes per oil immersion field) and for presumptive diagnosis of gonococcal infection
    • A culture of intraurethral exudate or a nucleic acid amplification test (either on intraurethral swab or first-void urine) for N. gonorrhoeae and C. trachomatis
    • Examination of first-void uncentrifuged urine for leukocytes if the urethral Gram stain is negative. A culture and Gram-stained smear of this urine specimen should be obtained.
    • Syphilis serology and HIV counseling and testing

References

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